Advancing Vaccine Access in Tanzania through Community Drug Outlets: A Pre-Implementation Survey on the Acceptability, Appropriateness, and Feasibility

Background Vaccination is a cost-effective strategy to prevent infectious diseases, yet access remains limited in Tanzania’s underserved regions. Integrating vaccination services into community drug outlets (CDOs), including pharmacies and Accredited Drug Dispensing Outlets (ADDOs) offers a potential solution to expand vaccine access. This study assessed the acceptability, appropriateness, and feasibility of implementing a CDO-based vaccination model in urban (Dar es Salaam) and rural (Pwani) settings. Methods A cross-sectional pre-implementation survey was conducted between March and April 2025 across randomly selected CDOs. A structured questionnaire, informed by validated implementation science frameworks, was administered to 452 clients and 220 dispensers. Likert-scale responses measured perceptions of acceptability, appropriateness, and feasibility. A threshold of ≥ 75% agreement was used to indicate the intervention is acceptable, appropriate and feasible. Modified Poisson regression identified factors associated with the three outcomes, using adjusted prevalence ratios (aPR) and a significance level of p < 0.05. Results While 75.7% of 452 clients expressed willingness to receive vaccines at CDOs, only 35.0% of 672 participants (clients and dispensers) overall rated the model as acceptable. Appropriateness and feasibility were reported by 64.9% and 53.9% of respondents (clients and dispensers), respectively. Clients generally viewed the model more favorably than dispensers (acceptability: 35.4% vs 34.5%; appropriateness: 69.0% vs 56.4%; feasibility: 59.2% vs 44.1%). Acceptability was significantly associated with greater distance to the nearest health facility (aPR: 1.47; 95% CI: 1.00–2.18) and willingness to receive vaccines at CDOs (aPR: 45.06; 95% CI: 6.27–324.02). Appropriateness and feasibility ratings were lower among participants aged ≥ 45 years and those from Pwani. Dispensers who owned their outlet and expressed willingness to provide vaccinations were significantly more likely to find the model acceptable (aPR: 1.46; 95% CI: 1.05–2.03) and feasible (aPR: 4.03; 95% CI: 2.30–7.08). Conclusion The integration of vaccination services into CDOs in Tanzania is moderately appropriate and feasible. Despite the potential of community-based vaccination models, challenges remain due to low acceptability among dispensers and limited readiness, particularly within ADDOs. A complementary qualitative study is underway to better understand stakeholder attitudes and contextual factors, providing insights to refine and optimize future implementation efforts.